Department of Cardiology, Asklepios Klinik St Georg, Lohmühlenstraße 5, Hamburg, Germany.
Asklepios Proresearch, Asklepios Klinik St. Georg, Lohmühlenstraße 5, Hamburg, Germany.
Europace. 2018 Sep 1;20(9):1459-1467. doi: 10.1093/europace/eux219.
Second-generation cryoballoon (CB2) based pulmonary vein isolation (PVI) has emerged as an effective treatment option for symptomatic atrial fibrillation (AF). The current study sought to assess the impact of different ablation protocols on the incidence and characteristics of procedural complications in a large patient cohort.
A total of 563 consecutive patients with symptomatic AF who underwent CB2-based ablation between July 2012 and January 2016, were assessed. Three different ablation protocols were applied and characterized by (#1) a bonus-freeze following PVI, (#2) no bonus-freeze after PVI, and (#3) a 'time-to-effect'-guided strategy. Major complications occurred in 30/563 patients (5.3%) with phrenic nerve palsy (PNP) as the most frequent complication occurring in 2.7% of the cases. The overall incidence of complications was significantly lower in patients treated with a 'time-to-effect' guided ablation strategy compared with the other ablation protocols (8.1% [17/211] (protocol #1+#2) vs. 3.7% [13/352] (protocol #3), respectively; P = 0.026). The 'time-to-effect' guided ablation protocol was associated with less applied freeze-cycles and shorter freeze-cycle durations. Additionally, shorter procedure times, radiation exposures and lower volumes of contrast medium needed were assessed for the 'time-to-effect' guided protocol as compared with the other ablation protocols.
The overall incidence of complications was 5.3% in our analysis. The most frequent complication was PNP. The use of a time-to-effect guided ablation protocol was associated with a lower incidence of major complications compared with a bonus-freeze and no bonus-freeze protocol.
第二代冷冻球囊（CB2）基于肺静脉隔离（PVI）已成为治疗有症状心房颤动（AF）的有效治疗选择。本研究旨在评估不同消融方案对大样本患者队列中程序并发症发生率和特征的影响。
共评估了 2012 年 7 月至 2016 年 1 月期间接受 CB2 消融的 563 例有症状 AF 连续患者。应用了三种不同的消融方案，并将其特征描述为：（1）PVI 后无冷冻球囊奖励；（2）PVI 后无冷冻球囊奖励；（3）“起效时间”指导策略。563 例患者中有 30 例（5.3%）发生主要并发症，其中膈神经麻痹（PNP）最为常见，发生率为 2.7%。与其他消融方案相比，采用“起效时间”指导消融策略的患者并发症总发生率明显较低（8.1%[17/211]（方案 1+2）与 3.7%[13/352]（方案 3），P=0.026）。“起效时间”指导消融方案与应用冷冻球囊循环次数减少和冷冻球囊循环时间缩短相关。此外，与其他消融方案相比，“起效时间”指导消融方案还评估了较短的手术时间、辐射暴露和较低的对比剂用量。
在我们的分析中，并发症总发生率为 5.3%。最常见的并发症是 PNP。与冷冻球囊奖励和无冷冻球囊奖励方案相比，采用“起效时间”指导消融方案与主要并发症发生率较低相关。
